Wednesday, June 20, 2012

Demise of Psychiatry: A Reading List

Everybody has read Whitaker and Breggin. Lots of people know of Grace Jackson. Szasz has his loyal disciples (I am one). Here are four books less on the radar, but equally as useful and significant.

American Madness: The Rise and Fall of Dementia Praecox, by Richard Noll (2011, Harvard University Press); and Crazy Like Us: The Globalization of the American Psyche, by Ethan Watters (2010, Free Press/Simon & Schuster). These two are really about history.

Noll covers a critical period of psychiatry in intense detail, from about 1895 to the 1930's, when the disease model of mental illness came and went. The lives, careers and mistakes of Emil Kraepelin, Adolf Meyer, Eugen Bleuler and other luminaries are detailed. Parallels with the present are striking, and the reader is seriously tempted to predict what will happen with DSM-5, purely based on history tending to repeat itself. Noll himself does not discourage this, although the connections seem to be an afterthought for him.

Watters is more of an investigative journalist. He chronicles the spectacularly successful promotion over the past two generations, of the biomedical model of mental illness around the world. In a sense, this recent history picks up almost exactly where Noll's left off, and it shows a returning swing of the pendulum, although neither Kraepelin nor Freud even appear in Watters' index. Each of the four stories told in this book - of the rise of anorexia in Hong Kong, the arrival of PTSD in Sri Lanka, the altered concept of schizophrenia in Zanzibar, and the mega-marketing of depression in Japan - is much more interesting with the backdrop of the earlier psychiatric century.

Aping Mankind: Neuromania, Darwinitis and the Misrepresentation of Humanity, by Raymond Tallis (2011, Acumen Publishing); and Rethinking Madness: Towards a Paradigm Shift in Our Understanding and Treatment of Psychosis, by Paris Williams (2012, Sky's Edge Publishing). These two books suggest a new look at what we can know and what we should do about the mind.

Tallis offers a highly respectable, technical/philosophical disputation of the intertwined ideas, that we are our brains and that consciousness is just another evolutionary adaptation. Aping Mankind is serious reading, but highly rewarding. One is compelled to respect the argument that ascribing thought to bits of brain is less scientific materialism and more mystic faith. The credentials of the author, who was elected a Fellow of the Academy of Medical Sciences for his research in clinical neuroscience, make him difficult to ignore.

Paris Williams is ideally suited to demonstrate the scientific and philosophical arguments of Raymond Tallis. Rethinking Madness is all about clinical and personal experience which points inexorably to the conclusion that the medical model of mental illness is destructive, and must be replaced by a recovery model wherein people can integrate personal experience and overcome distress. Attempts to make people happier and safer by fine-tuning their brain chemistry are shown to be a mistaken and generally dehumanizing project. Psychosis is not brain disease, and schizophrenia does not really even exist.

Read these four books, and then just try to imagine that the demise of psychiatry as we know it is not imminent. It will be hard.

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